12y/o FS Labrador Retriever, Approx. 38Kg. History of hip soreness, exercise intolerance, and obesity. Hips X-rayed at UC Davis, summer 2016. One pound lipoma causing gait deficit removed from R inguinal region in October of 2016.
I treated Bailey for GI issues and constipation in early January, and noticed that she was once again favoring the RR leg after two months of improvement after the lipoma removal. However, this time, the stifle joint was clearly unstable (positive drawer sign without sedation) and painful to palpation. She was 4-4.5/5 lame on the leg, standing with leg up, and consistently pivoting on the LR leg to change direction.
On January 25th, 2017, I injected Bailey’s R Stifle joint with Kush as follows:
Bailey was given 0.29cc Dexdomitor (dexmedetomidine 0.5mg/mL) IM 15 minutes prior to the procedure. I shaved the cranial aspect of the stifle, cleaned the skin with chlorhexidine scrub and alcohol. The skin was “frozen” using Gebauer’s ethyl chloride spray, and the skin over the middle patella tendon was blocked with 0.5mL bupivicaine.
The skin was prepped with chlorhexidine solution, and the leg gently flexed. Using a 22g, 3⁄4” needle attached to the Kush syringe, I drew 0.1mL (4mg) of Kenalog (triamcinolone acetate) into the Kush syringe, and entered the joint capsule through the middle patellar tendon. I aspirated for a “flash” of joint fluid, and then I slowly injected the material into the joint with no resistance to flow. I kept the dog recumbent for 5 minutes post injection.
She also received a 1mL (100mg) dose of Adequan (polysulfated glycosaminoglycan) IM, and will receive 75mg of Rimadyl (carprofen) once daily as recommended by UC Davis. I personally believe that this dose is insufficient. I informed the client that at COX-2 inhibitor might be a better choice, and that the Adequan injection should be repeated in 30 days.
On January 30th, I observed Bailey’s movement 6 days post-injection. Mobility in the RR stifle joint is still increased, but she is now only 1-2/5 lame on RR after exercise, and does not hold the leg up when stationary. She is now climbing stairs and running freely on flat grassy surfaces in the Town Center Park for 30 minutes without limping or holding up leg. The plan is to continue the current exercise regimen for thirty days to build muscle mass. Bailey has lost at least 5 pounds in the last week with increased exercise.